Gastroesophageal intussusception is an uncommon condition in dogs in which the stomach invaginates into the esophagus, causing severe patient morbidity. Unlike hiatal hernia, the gastroesophageal junction remains in its normal anatomic position.1 A review of the existing English veterinary medical literature on the subject reveals that most reported cases of GEI in dogs involve dogs ≤ 6 months of age (28 of 38 [74%] cases for which age was reported) and males are over-represented (20 of 27 [74%] cases for which sex was reported).1–28 German Shepherd Dog is the most commonly reported breed, accounting for 57% (21/37) of reported cases for which breed was reported.
Clinical signs of GEI in dogs include dyspnea, regurgitation, and vomiting and may be acute or chronic in duration or represent an acute flare-up of a chronic condition (ie, acute on chronic).1,29 No specific underlying cause has been found for this condition; however, abnormalities of the esophagus, including megaesophagus, dysmotility disorders, and laxity of the esophageal hiatus are believed to predispose dogs to GEI,29 with 50% of dogs in 1 study1 having preexisting esophageal abnormalities.
The diagnosis of GEI can often be made through abdominal radiography, which typically reveals a soft tissue mass within the caudal portion of the esophagus and no evidence of the stomach within the cranial portion of the abdomen.16,20,23,29 Megaesophagus and aspiration pneumonia are common concurrent findings. Oral administration of positive contrast medium may help to highlight the invaginated stomach and may reveal rugal folds within the esophagus.23 Endoscopic evaluation of the esophagus may also assist with diagnosis when rugal folds can be seen in affected dogs.13,23
Treatment of GEI requires reduction of the intussusception with left-sided or bilateral gastropexy to prevent recurrence.29 Surgery is the most common method of treatment, although there are 2 case reports13,23 of endoscopic reduction of the intussusception with PEG tube placement to achieve gastropexy. In the largest report of dogs with GEI to date,1 95% (21/22) of dogs died or were euthanized, many of which did not undergo surgical treatment. More recent case reports3,6,28 have documented successful treatment with long-term patient survival after prompt diagnosis and aggressive treatment. The objectives of the study reported here were to characterize a large group of dogs with GEI and determine long-term outcomes and risk factors for those outcomes.
The authors declare that there were no conflicts of interest.
Presented as an abstract at the Society for Veterinary Soft Tissue Surgery Annual Meeting, Asheville, NC, June 2019; and the American College of Veterinary Surgeons Surgery Summit, Las Vegas, October 2019.
Percutaneous endoscopic gastrostomy
JMP, version 13.1, SAS Institute Inc, Cary, NC.
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